Strategic Information on Adolescent Health Ministry of Health and Family Welfare India

Existing MIS for National Reproductive and Child Health (RCH) Programme Routine MIS: Monitoring of RCH programme Periodic National Surveys: Tracking improvement in health (RCH) status –National Family Health Survey (NFHS): National and State level data –District Level Health Survey (DLHS): District level data Special Surveys

Limitations There is a limited age and sex disaggregated RCH data available related to the adolescents and young people Such strategic information is indispensable for advocacy, formulating policies, and developing rational programmes for adolescent health and development Paucity of data comes in the way of developing specific strategies for special groups among this rather heterogeneous section of population

NFHS Round 1 ( ), Round 2 ( ), Round 3 ( ) Provides estimates of important family welfare and health indicators by background characteristics at the national and state levels Measures trends in family welfare and health indicators over time at the national and state levels Limitations –No men and unmarried men and women included in NFHS 1 and NFHS 2 –Youth Sample at sub-national may not permit detail analysis

NFHS 3 New areas included: Perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, tuberculosis, and malaria 230,000 women age and men age throughout India NFHS-3 tested more than 100,000 women and men for HIV NFHS-3 also tested more than 200,000 adults and young children for anemia.

DLHS The main focus of the DLHS-RCH has been on the following aspects: Coverage of ANC & immunization services Proportion of safe deliveries Contraceptive prevalence rates Unmet need for family planning Awareness about RTI/ STI and HIV/AIDS Utilization of government health services and users’ satisfaction Limitations: –Unmarried men and women not included –Youth Sample at sub-national may be a problem but much larger then NFHS

DLHS DLHS 1: DLHS-2: : –593 districts as per the 2001 Census –A total of 620 thousand households were covered –Interviewed 507 thousand currently married women (aged years) –Interviewed 330 thousand husbands of eligible women were

Secondary Analysis of existing data Objectives: Secondary analysis of raw data collected under NFHS (1 and 2) and DLHS 2 rounds To obtain age disaggregated data on sexual and reproductive health issues for the age group years To obtain an insight into the trends over these national surveys Steps: –Obtaining micro-data of the surveys –Data merging and preparation –Generation of tables and their validation

Secondary Analysis Age Blocks: 15-19, and years. Domains: –Socio-demographic profile –Marriage –Morbidity –Fertility and Family planning –Maternal health –Child health and immunization –Anemia, level of nutrition –Health seeking behaviour –Knowledge awareness about RTI &STI –Knowledge awareness about HIV/AIDS

Youth in India: Situation and Needs Study ( ) Population based study To provide information on: –Situation of youth –Life choices available to them on range of SRH issues –Behaviours and their antecedents For evidence-informed programming

Specific objectives  Identify key transitions facing youth, including education and livelihoods opportunities and experiences  Build evidence on the magnitude and patterns of sexual and reproductive practices in and outside of marriage  Identify the key factors underlying their sexual and reproductive health and choices  Advocate for evidence-based programming for young people

Scope: Covers Six States of India Phase I Phase II Maharashtra Jharkhand Tamil Nadu Andhra Pradesh Bihar Rajasthan

Scope contd… For the first time, interviews conducted with: Never Married Males & Females aged years Married Males aged years Married Females aged years

Scope contd… For each of Six state covered, the study would provide separate estimates for: Rural & Urban areas Male & Female populations Married & Unmarried population

Overall Sample Size Rural Urban A: Unmarried Females (15-24) Males (15-24) B: Married Females (15-24) Males (15-29) Total Sample Size: One State: (approx.) Six States: (approx.)

Domains of reporting Socio-demographic profile YP control over their own life SRH knowledge Pre-marital relationships Self reported health problems Youth life style Programme participation and voting experience Married life

% youth reporting premarital sex and % sexually experienced reporting consistent condom use, Maharashtra, Jharkhand, Tamil Nadu (Youth Study) Source: IIPS and Population Council 2007; forthcoming for Jharkhand and Tamil Nadu

Marriage and regular exposure to sex initiated early Females Almost half of all females marry before age 18 About one third of young men marry before age 21 % females aged married by age 18 fell only from 50% to 47% between and (NFHS2 and NFHS3)

% unmarried youth aware of selected SRH matters Source: IIPS and Population Council 2007 Maharashtra Jharkhand Superficial awareness relatively high but in- depth awareness limited Large gender differences in awareness

% youth reporting parents discussed various SRH matters Cont… Parents rarely a source of information (except menstruation for girls) Significant sources of information: Peers reported by 19%- 28% of females and 55%- 76% of males Media: 16%-67% females and 40%-63% of males Perpetuating the cycle of misinformation? Source: Youth Study, Maharashtra and Jharkhand Maharashtra (unmarried) Jharkhand (unmarried)

% approving of school based sex education, by topic Source: IIPS and Macro International 2007 (NFHS3) % of women who say that topic should be taught in school % of men who say that topic should be taught in school % approving any topic: females: 40%-75% males: 60% -80% % approving HIV education Females: 63% Males: 81%-82% % approving education on sex Females: 43%-46% Males: 62%

% reporting pre-marital sex by whether or not school based sex education was received Maharashtra Tamil Nadu Global review (>80 programmes): Sex education does not lead young people to engage in sex: no or + association with age at 1 st sex; condom use, single partner relations (Kirby 2005) No studies/assessments available from India – but preliminary Youth Study data suggest that compared to those not exposed to school based SE, those who were exposed were less or as likely to have experienced pre-marital sex Source: IIPS and Population Council 2007

Youth assessment of school-based sex and family life education Exposure to SE varied by state: –Jharkhand: <10% –TN: 20% –Maharashtra: 12% (M) and 31% (F) Youth assessments generally positive but large %s report embarrassment Maharashtra Jharkhand Tamil Nadu Source: IIPS and Population Council 2007 (Youth Study)

Next Steps Analysis of Adolescent Module of NFHS 3 Completion of secondary analysis DLHS 3: –Incorporation of selected YP coverage indicators: HIV test, - within past one year –Incorporation of certain adolescent SRH indicators: e.g. Use of sanitary napkins, Em. Contraceptive pills Boys / young men to be included in the surveys Routine MIS for RCH: Incorporation of selected ARSH indicators

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